ABSTRACT
Cardiac tamponade after ventricular assist device or total artificial heart implantation can typically occur within days or weeks after surgery. This report describes the case of a woman who presented over 4 years after SynCardia 70cc total artificial heart implantation, with physiology consistent with right ventricular outflow tract obstruction. The cause was initially attributed to device membrane failure based on the device console waveform; however, during operative exploration, a large amount of proteinaceous exudate was surrounding the device and causing the obstruction. This report illustrates how tamponade can result years after device implantation, secondary to porosity of the outflow grafts.
Subject(s)
Cardiac Tamponade/etiology , Heart Failure/surgery , Heart, Artificial/adverse effects , Postoperative Complications , Prosthesis Implantation/adverse effects , Cardiac Tamponade/diagnosis , Female , Follow-Up Studies , Humans , Middle Aged , Time Factors , Tomography, X-Ray ComputedABSTRACT
We present the rare case of a primary gastro-aortic fistula involving the native aorta and proximal stomach in a patient with a chronic gastric ulcer and prior history of Nissen fundoplication. Our case highlights the importance of keeping this rare and fatal condition as a differential diagnosis in patients with prior history of Nissen fundoplication surgery.
ABSTRACT
Serum biomarkers detect the earliest events in disease, monitor management, and provide insight into disease pathogenesis. At this time, there are no biomarkers available for otologic disorders. Otolin-1 is a scaffolding protein exclusively expressed in otoconia and cells of the vestibule and the cochlea; therefore, it may be a biomarker candidate for assessing the health of the inner ear. As a proof of concept, we used serum samples from controls without otologic history and subjects with a history of benign paroxysmal positional vertigo (BPPV), performed enzyme-linked immunosorbent assay for otolin-1, and measured the optical density of the substrate. Otolin-1 was detectable and quantifiable in all subjects, indicating that this inner ear protein crosses the blood-labyrinthine barrier. Furthermore, subjects with BPPV had significantly higher levels, with about one-third being above the control range. This promising preliminary result suggests that inner ear-specific proteins have the potential to serve as biomarkers for otologic disease processes.
Subject(s)
Benign Paroxysmal Positional Vertigo/blood , Benign Paroxysmal Positional Vertigo/physiopathology , Extracellular Matrix Proteins/blood , Otolithic Membrane/metabolism , Aged , Biomarkers/blood , Case-Control Studies , Disease Progression , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Humans , Middle Aged , Otolithic Membrane/physiopathology , Postmenopause , Predictive Value of Tests , Reference Values , Risk Assessment , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
INTRODUCTION: Alexander disease is a disorder caused by a mutation and accumulation of the glial fibrillary acidic protein. Currently, three subtypes are acknowledged: an infantile, a juvenile, and an adult form. However, onset early in infancy or in the prenatal period has been shown to present with a uniform pattern of symptoms-suggesting the presence of a distinct neonatal form of the disease. RESULTS AND DISCUSSION: Though the neonatal form of Alexander disease is not well acknowledged, a uniform and distinct presentation of the disease in neonates has been observed, suggesting the need for a different course of identification and treatment. Clinical presentation of the neonatal form is distinguished by leukodystrophy and generalized, frequent, and intractable seizures. While the infantile form presents with ataxia, hyperreflexia, and other upper motor neuron symptoms, none of these has been observed in the neonatal form. In the diagnosis of neonatal Alexander disease, it is essential to rule out other causes of leukodystrophy and the presence of neoplasms.
